When Roy received the call from Dr. Brackett at 7:00 am asking him to come to his office upon arriving at Rampart, his heart leapt into his throat. Things were going well after the surgery, despite the regression that Roy had managed to ignore the cautions from the doctors that Johnny was not completely out of the woods yet. So, with that one phone call and a quick explanation to Joanne, instead of eating breakfast with the family before heading to the hospital as planned, by 7:10, Roy was on the road already. By 7:30, he was pacing the length of Dr. Brackett's office, waiting for him to finish with an emergency patient.
"Sorry for the wait, Roy. Why don't you have a seat," Dr. Brackett suggested as he entered after a nerve wrecking ten minute wait.
Complying, Roy sat on a chair across from the desk, bracing himself for bad news. As Dr. Brackett took the chair besides him, all Roy thought about was, did something else pop-up that they didn't see? Did John develop some sort of an infection? Did he slip into a coma? Did things worsen to the point that more brain damage was caused and this time, it was permanent?
It seemed as though his thoughts were punishing him for ignoring the fact that despite Johnny overcoming many difficulties and challenges already, Roy had blatantly ignored the fact Johnny was far from being out of danger. With the guilty and ghastly thoughts running rampant, Roy was grateful when Dr. Brackett finally finished organizing his thoughts and began speaking.
"After the two of you left last night, Johnny became more agitated as time went on and fought the medication we gave him. Eventually, it grew to the point where, despite increasing the medication, Johnny refused to allow himself to relax enough to sleep and it got to the point where he was very uncooperative with Nurse Fitz. What was worse, we believe his mood, as well as his state of mind, was effected his blood pressure, causing it to increase. I know you hate the idea of this, but around midnight, Johnny had to be restrained so that the nurses and Dr. Early could give him a sedative. It also allowed the x-rays Doctor Early had ordered to be taken. The skull series showed that the swelling had increased again, which was likely not helping John's mood or ability to cope.
"You know, as well as I and Doctor Early that that is not a good thing, so Dr. Early added 10 mg of diazepam every hour while dropping the dexmedetomidine a bit. It was not the ideal situation to reduce the dexmedetomidine then as we had hoped to wait until noon today," seeing the anger brewing on Roy's face for what he likely saw as a scenario where he should have been consulted, Dr. Brackett held up his hand. "Let me explain. Dr. Early knew that if John's blood pressure continued to rise, he could possibly have had a stroke, seizure, or more bleeding could have occurred. Also, Johnny ran the risk of brain herniation or permanent brain damage just from the pressure alone. By adding the diazepam, it means that Johnny can rest and not worry, which has brought his blood pressure down significantly.
"The reason for that Doctor Early reduced the dexmedetomidine twelve hours earlier than we had previously discussed is because that medication can interfere with the effectiveness of diazepam. Considering that the repeat x-ray at 5 am shows that the swelling, which had increased, is now back to where it was before the blood pressure issues, I have to agree with Dr. Early's decision. I am sure you think you should have been called and you would have, if things had not resolved as soon as they did or more complications had arisen. It was more important that you got rest as I am sure you haven't been sleeping too well."
Running his hands though his hair that he swore was even thinner than two weeks ago, Roy sighed heavily.
"You're right doc, and I trust you two, it's just that, well " stumbling over his thoughts, Roy couldn't figure out how to explain how he felt.
"I know," Dr. Brackett said softly. "Quite honestly, I had to force Dr. Early to go home after the last x-rays. Dixie hasn't been sleeping well and I think if it wasn't for the fact for her job, she would be lost. Half the time she spends her breaks just sitting doing nothing and the other half she spends trying to find out what she can to help Johnny."
"Yeah, I talked to Dix while I was waiting. She checks in on him whenever possible, but like she says, it's not the same when you have to be careful that the person you care about can't know you are there."
"Like you and Johnny, Dixie and he had, have, some sort of special connection," Dr. Brackett had to remind himself to speak in present terms. Just because Johnny didn't remember them at this moment, it didn't mean that they had to forget about him or the friendship they had.
"What about you, how are you doing?" Roy asked tentatively, unsure if he was overstepping his boundaries. However, the dark circles were a lot more pronounced than he had ever seen them on Dr. Brackett.
"This is scaring the heck out of me to be truthful. Right now, I am the doctor who is in charge of Johnny's case until tonight until the other neuro guy, Doc Swarl, comes in. Whenever John is awake and I am even in the same room, he gets this terrified look. I have no idea why, and although I am curious, I'm not sure if I want to know."
What Dr. Brackett didn't mention was that both he and Dixie were afraid that due to him being raised on a reservation until he was almost a teenager, some male figure misused his position after Johnny lost his parents. They were both worried that he suffered from some sort of abuse or trauma cause by someone in authority. Based on what they knew from his medical records and just knowing him through the years, they could reasonably deduce it didn't go to the point where physical evidence was left over. However, that still left verbal abuse and physical abuse was still a possibility.
Considering both of them were stressed beyond their normal limits, Dix and Kel both admitted to each other that they honestly didn't know how the DeSoto's were handling things as well as they were. Both of them were struggling to function normally and carrying on as they needed to in the emergency room. They were so much alike in the fact the frustration over not being to do much of anything meant that the two of them had to force themselves to eat and sleep at times.
Kel Brackett just wondered how Dixie managed to hide that at times while working, she would need to hide away in his office, just to escape. He knew without the solitude of this office that allowed her to grieve and just take a breather, she may have well broken down in front of others. Dixie felt as though she needed to be strong for everyone and thus, no one but him saw the tears, anger, worries, or frustration.
Then again, he reflected. Dix is the only one I have really allowed myself to vent my worries and frustrations to as well. I don't know how she does her job like these days are like any other days. Even I know I am more impatient than usual and have a problem with my temper around the staff. Thankfully, they are more than understanding. Even Mike Morton has been helping out more here in the Emergency department isn't so unusual, but I never would have though he'd willingly offer his help with Johnny's case considering how the two of them have gotten along before.
Giving himself a mental shake, Dr. Brackett returned to a topic he would rather avoid. Besides, there was a rare look of impatience on Roy's face and he really didn't want to push Roy. If he, as only a good friend of John's on the job was having such a difficult time coping with the realities of the head injuries, Roy must be going through sheer hell.
"Who knows what happened between the time his parents died and his aunt brought him to California? Maybe someday, Johnny will tell us."
Moving on quickly, Dr. Brackett said, "Anyway, the other two subjects I wanted to discuss is that Dr. Druthers says you can go see him for your appointment between 9:30 and 11 am. After that, you can choose either a set time for the next day or have a general time in the morning you would like to see him. He said to have Joanne come on up anytime after you're appointment and the kids can come see him right after school. While waiting for their sessions, I cleared it so they can go to the peds playroom."
"Why is he so flexible about the time?" Roy questioned suspiciously.
"Dr. Druthers was actually set to go on a working sabbatical for about four to five months in a week so the took this week off. Since this was an opportunity of his choosing, he was able to postpone for another time. Dr. Early and I were putting out feelers for who might be able to help since we had assumed he'd be unable to, but thankfully, after hearing about this situation, he was more than willing to help. In the past, Dr. Druthers has worked with Dr. Bates, a psychologist who specializes in traumatic brain injuries. Druthers told me that in between, he can do research that will help your family, prepare handouts, notes and a rough schedule to help your family and crew, as well as start to figure out where everyone can visit New Horizons. Once he learns more about what the specific needs are, he will be able to modify and ensure that the notes and schedule will work out for everyone. You will be in great hands.
"I guess at least we have that one thing on our side," Roy sarcastically observed.
"The other topic is the fact that since we have Johnny on the diazepam and it is working well so far, we would like to continue to do so for the next two days, perhaps even three days. As you know, at least it won't require him to be intubated and both Doctor Early and I feel this might be the best way to help him heal. It will give the swelling a way to hopefully diminish faster as well as help his body heal from the cuts and burns. The only downside would be that it may push back his therapy, both with the physical and Dr. Druthers, but it wouldn't be much of a setback."
"Sure doc, that sounds fine. We can still visit though, right?"
"Of course. Whenever you'd like. He may benefit from it, as even with all the medications, Johnny is still fidgeting."
"Typical," Roy smiled a small, worn out smile. "Just give me whatever paperwork you need me to sign and then if you don't mind, I think I am going to visit with Johnny for a bit before heading to see Doctor Druthers."
"Sounds good," Dr. Brackett patted him on the back as he got up to get the needed paperwork. "Take your time. When you're ready, you can find Druthers on the 8th floor, room 816."
Signing the forms out, Roy nodded and thanked him again before opening the office door to leave. Once outside the office, he headed to the nearest men's room. Sitting down inside a stall, he tilted his head back and for the first time since this whole incident began, tried to swallow down bitter tears that were forming. He just honestly didn't know what he would do without Johnny in his life and it had finally started to sink in how close he had come to losing John, not to mention, there was still too many things that could go wrong. Deciding that sitting around feeling miserable wasn't going to help, Roy got up, washed his face and headed out, once again determined to keep fighting.
AN: Brain herniation puts extreme pressure on parts of the brain and thereby cuts off the blood supply to various parts of the brain. It is often fatal.
Symptoms:
Cardiac arrest
Coma
Headache
Lethargy
Loss of all brainstem reflexes (such as blinking, gagging, pupils reacting to light)
Loss of consciousness
Respiratory Arrest
Wide (dilated) pupils and no movement in one or both eyes